Acetylsalicylic acid enhances arrhythmogeneity in a model of local ischemia of isolated rabbit hearts.
Acetylsalicylic acid often is used in the treatment and prophylaxis of regional myocardial ischemia and infarction. However, only little is known about its electrophysiological effects and on possible proarrhythmic effects of the drug. Thus, the aim of this study was to evaluate the electrophysiological effects of acetylsalicylic acid in normal isolated saline perfused rabbit hearts and in hearts submitted to regional ischemia. Isolated saline perfused rabbit hearts were treated with increasing concentrations of acetylsalicylic acid (0.05, 0.1, 0.5 and 1 microM). The epicardial activation and repolarisation process were analysed using an epicardial mapping (256 unipolar leads). Activation and repolarisation time were determined for each electrode from which data the 'breakthrough-points' of epicardial activation were determined. At each electrode an activation vector was calculated giving the direction and velocity of the local excitation wave. The similarity of selected heart beats compared to the control was evaluated by determination of the percentage of identical breakthrough-points and of similar vectors (deviation < or = 5 degrees). At each electrode the local epicardial action potential duration was assessed as the activation recovery interval and the standard deviation of the epicardial action potential duration (of 256 leads, = dispersion) was determined. In a second series of experiments 30 min regional ischemia was induced by occlusion of the left descendent coronary artery followed by 30 min reperfusion in the absence or presence of 0.5 microM acetylsalicylic acid or 1 micro/M indomethacin. The degree of ischemia was assessed by the reduction in coronary flow, by the degree of ST-elevation and by the area in which ST-elevation was registered. Under non-ischemic conditions acetylsalicylic acid led to an increase in the epicardial action potential duration (7%), a decrease in the breakthrough-point similarity (by 10%) and vectorfield similarity (by 15%). In control hearts submitted to regional ischemia the similarity of the vectorfields and of the breakthrough-points, as well as the duration of the epicardial action potentials were markedly reduced while the dispersion was greatly increased. In the ischemic region there was a significant ST-deviation from the isoelectrical line. These changes of ST-segments were significantly enhanced by 0.5 microM acetylsalicylic acid, so that in all (7/7) acetylsalicylic acid treated hearts sustained ventricular fibrillation occurred after 20 min ischemia, whereas in the absence of acetylsalicylic acid fibrillation was found in only 2/7 hearts during reperfusion and not during ischemia. 1 microM indomethacin did not cause these changes. In all ischemia/reperfusion series of experiments the reduction in coronary flow and left ventricular pressure by ischemia was of the same degree and we did not observe significant differences in the size of ischemic area. Using 14C-acetylsalicylic acid, an accumulation of acetylsalicylic acid in the ischemic region could be observed. From these results we conclude, that acetylsalicylic acid can induce ventricular fibrillation. Thus, in acute myocardial ischemia, acetylsalicylic acid may have (besides the well known and desired antiaggregatory effects) electrophysiologic side effects which seem to be proarrhythmic in regional ischemia at least in this model.
Dhein
S
S
Institute of Pharmacology, University of Cologne, Germany. stefan.dhein@uni-koeln.de
Gottwald
M
M
Gottwald
E
E
Hohlfeld
T
T
Salameh
A
A
Klaus
W
W
D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000097:blood / Q000494:pharmacology*; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001241:Aspirin / Q000097:blood / Q000494:pharmacology*; D003326:Coronary Circulation / Q000187:drug effects; D004594:Electrophysiology; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D008297:Male; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000503:physiopathology; D015425:Myocardial Reperfusion; D011817:Rabbits; D014693:Ventricular Fibrillation / Q000209:etiology*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin